The Fields Marked With (*) are Essential.

                                Name Of Organisation:*    

                                Address:*                            

                                 Phone / Fax:*                      

                                 E-Mail:*                              

                                 Contact Person                  

                                    &  Designation

                                  Type Of Machine:              

                                   Medium To Be Sealed:        

                                  Temperature:                          

                                   Pressure in Bars:              

                                  Seal Kit Details:                                                    

                                  Seal Installed To Date:     

                                                   Make:               

                                                   Imprinted No:   

                                     Type Of Seal:                  

                                      Profile:                           

                                      Quantity:                       

                                      Comments:                     

        You may send Samples / Drawings of Groove details which will be returned  

        immediately